Employment Application

I acknowledge and understand that Rehab Home Health, Inc., may contact my previous employers. I authorize those employers to disclose information pertinent to my employment with them. In addition to authorizing the release of any information regarding my employment, I hereby waive any rights to or claims I have or may have against my former employers, their agents, employees, and representatives, as well as individuals who release information to Rehab Home Health, and release them from any and all liability, claims, or damages, that may directly or indirectly result from the use, disclosure of any such information by any person or party, whether such information is favorable or unfavorable to me.

I hereby state that all the information that I provided on this application or any other documents filled out in connection with my employment, and in my interview are true and correct. I have withheld nothing that would, if disclosed, affect this application unfavorably. I understand that if I am employed and any such information is later found to be false or incomplete in any respect, I may be subject to disciplinary action up to and including termination.

If hired, I agree as follows: My employment and compensation are at-will, are for no definite period, and my employment and compensation may be terminated by either Rehab Home Health or myself at any time and for any reason whatsoever, with or without good cause.

Should any term or provision, or portion thereof, be declared void or unenforceable it shall be severed and the remainder of this Agreement shall be enforced.

DO NOT CHECK THE “YES” BOX UNTIL YOU HAVE READ THE ABOVE STATEMENT & AGREEMENT. IF YOU HAVE ANY QUESTIONS REGARDING THIS STATEMENT, PLEASE ASK A REHAB HOME HEALTH REPRESENTATIVE BEFORE SIGNING.